SURGICAL-TREATMENT OF DIABETES-MELLITUS WITH PANCREAS TRANSPLANTATION

Objective The authors compared results and morbidity in insulin-depend ent diabetes mellitus (IDDM) patients undergoing preemptive pancreas t ransplantation (PTx) either before dialysis or before the need for a k idney transplant with IDDM patients undergoing conventional combined p ancreas-kidney transplantation (PKT) after the initiation of dialysis therapy. Summary Background Data Combined PKT has become accepted gene rally as the best treatment option in carefully selected IDDM patients who either are dependent on dialysis or for whom dialysis is imminent . With improving results, the timing of PKT relative to the degree of nephropathy is evolving. However, it is not well established that the advantages of preemptive PTx can be achieved without incurring a detri mental effect on graft function or survival. Methods Over a 4-year stu dy period, data on the following 3 recipient groups were collected pro spectively and analyzed retrospectively: 1) 38 IDDM patients undergoin g combined PKT while on dialysis (PKT:D); 2) 44 IDDM patients undergoi ng preemptive PKT before dialysis (PKT:ND); and 3) 20 IDDM patients un dergoing solitary PTx. All patients underwent whole organ PTx with bla dder drainage and were treated with quadruple immunosuppression. Resul ts Actuarial 1-year patient survival is 100%, 98%, and 93%, respective ly. One-year actuarial PTx survival (insulin-independence) is 92%, 95% , and 78%, respectively. The incidence oi rejection, infection, operat ive complications, readmissions, and total hospital days was similar i n the three groups. Long-term renal and pancreas allograft function an d quality of life were similarly comparable. Rehabilitation potential favored the solitary PTx and PKT:ND groups.Conclusions Preemptive PKT or solitary PTx performed earlier in the course of diabetes is associa ted with good results, facilitated rehabilitation, and may prevent fur ther diabetic complications.